Difference between revisions of "Septic arthritis of the hip (peds)"

(Created page with "==Background== - hematogenous spread or local inf. - wt. bearing joints most common - knee (40-50%) - hip (20- 25%) - staph, S. Pneumo, group A strep - in neonates also Gr...")
 
(Diagnosis)
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==Diagnosis==
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== Diagnosis ==
 
 
  
 
Age - 6 mo to 8 yrs
 
Age - 6 mo to 8 yrs
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Xrays - possible effusion
 
Xrays - possible effusion
  
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- may present w/ referred knee or thigh pain
 
- may present w/ referred knee or thigh pain
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- get Bld Cxs (40-50% grow out)
 
- get Bld Cxs (40-50% grow out)
  
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- Xrays useful to exclude other cause of joint pain (AP & Frog leg)
 
- Xrays useful to exclude other cause of joint pain (AP & Frog leg)
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- CT may be useful to look for abscess, UTZ for effusion.
 
- CT may be useful to look for abscess, UTZ for effusion.
  
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'''Kocher Criteria'''
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1. ESR > 40
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2. WBC > 12
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3. Refusal or inability to weight bear on affected joint
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4. Fever
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1/4 criteria met --> 3% have septic joint
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2/4 --> 40%
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3/4 --> 93%
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4/4 --> 99%
  
 
==Treatment==
 
==Treatment==

Revision as of 22:37, 20 June 2011

Background

- hematogenous spread or local inf.

- wt. bearing joints most common

- knee (40-50%)

- hip (20- 25%)

- staph, S. Pneumo, group A strep

- in neonates also Groub B strep % gram neg.

Diagnosis

Age - 6 mo to 8 yrs

Pres - Pain, Pseudoparalysis

Labs - ESR > 20 after 1-2 d, WBC >

Xrays - possible effusion


- may present w/ referred knee or thigh pain

- usually hold jt in flexion, ext rotat & slt abduction.

- get Bld Cxs (40-50% grow out)


- Xrays useful to exclude other cause of joint pain (AP & Frog leg)

- CT may be useful to look for abscess, UTZ for effusion.


Kocher Criteria

1. ESR > 40

2. WBC > 12

3. Refusal or inability to weight bear on affected joint

4. Fever

1/4 criteria met --> 3% have septic joint

2/4 --> 40%

3/4 --> 93%

4/4 --> 99%

Treatment

- drainage

- Oxacillin, Nafcillin or Clinda in pen all

- cover H. inf as needed w/ 3rd gen

ceph.

- IV abx for 10-14 days before po


See Also

Peds: Hip Pain


    • SEPTIC JOINT***
  • usu acute, same mech as OM, usu similar org w/ s. aureus most common (think gc if older).
  • Rx= aspirate sufficient for all xcept hip, must go to OR/IR w/ hip b/c incr pressure can cause avn of hip! o/w tap okay, usu OR if reaccumulates. send for (in order) 1) cx 2) count 3) gs.
  • CBC >15 in 50%, ESR >60mm/hr in >90% of cases, CRP >20mg/L in 94%, Bcx 50%, fluid usu >50,000 WBC

(in gc arthritis: +blood cx: ~0%, +fluid cx/gs: 25-50%, urethral/rectal/throat swab may incr cx yield)

  • xr for septic hip usu w/ joint space wide of >1-2 mm vs other side
  • Rx= neonate ox & gent, 2mo-5yr cefotax & ox, 5y-12y ox (vanco?), >12 ox & ctx